Providers say mental health services to suffer if state cuts enacted

Hartford - Mental health experts who spoke before the governor's Sandy Hook Advisory Commission on Friday said they oppose the governor's $63 million cut to mental health services in 2014 and 2015.

"I understand the pressures Gov. (Dannel P.) Malloy is under to establish a budget. At the same time, these kinds of cuts have already translated into the elimination of core grants that keep the mental health system going," said Harold Schwartz, a commission member and vice president of behavior health at The Institute of Living at Hartford Hospital.

Malloy's two-year budget calls for reducing state subsidies for underinsured and uninsured individuals by $63 million. The reasoning was that by Jan. 1, 2014, more people would be insured under the Affordable Care Act. Therefore, clinics providing mental health services would receive Medicaid or private insurance payments for their services instead of needing state subsidies.

But mental health providers say enrollment in Medicaid and insurance plans won't happen overnight, and the funding under Medicaid only covers 50 percent of their costs. Currently, the state subsidies cover nearly 100 percent of their costs, Schwartz said.

While the governor's administration hears the concerns, Malloy spokesman Andrew Doba said, they are unfounded.

"The governor's budget doesn't cut services, it just changes who pays for them," Doba said. "Whatever was reduced, they are getting back as we implement the Affordable Care Act."

But Schwartz said without the $63 million in grants, which support outpatient clinics at a variety of facilities, those parts of the care system for individuals with mental illness are not sustainable.

"Clinics around the state are at risk for closing access to inpatient beds and other levels of care are at risk for going away," Schwartz said. "And all of these patients … would be accessing it through overcrowded emergency rooms that will back up in unsustainable ways, leading many to not seek care."

"For (Malloy) to be cutting the budget at a time where there is a need for mental health services doesn't make a lot of sense to me," she said.

A $63 million cut would prevent Waterbury-based Wellmore Behavioral Health from responding to clients as quickly as it does now, said Gary Steck, CEO of the private nonprofit, which typically responds to crises in 30 to 45 minutes.

Steck said it is important to address a problem immediately as someone who calls in to seek substance abuse support and has to go on a waitlist is less likely to show up for an appointment later.

Providers already are beginning to make plans to shut down or sharply reduce their services because of proposed cuts, said Sheila Amdur, interim president and CEO of the Rocky Hill-based trade association Community Providers Association in a written statement to the legislature's Human Services Committee on Tuesday.

"The governor is proposing cutting all of those grants without adjusting the underlying Medicaid rate," Amdur told the commission Friday. "They are saying now everybody is going to be covered by Medicaid. Well, sure, but it's not going to cover the costs that the grants covered, so let's look at payment reform."

She said under the Affordable Care Act, the Medicaid rate for primary care is being increased to match the rate for Medicare, which is higher. But the rate for Medicaid for behavioral health services will remain about 60 percent of the Medicare rate.

The federal government is paying the state to raise the rate for primary care because they recognize that there have to be rates that primary care physicians will accept, she said.

But "that doesn't apply to any of the behavioral health treatment," she said.

"That's why, if you go to a private psychiatrist or clinician in New London, almost no one is going to take Medicaid patients because it doesn't pay them enough," Amdur said, adding that the demand for services is so high that providers don't need to find ways to accept patients who can't pay.

Commission chairman and Hamden Mayor Scott Jackson said he agreed that demand for mental health providers was high, but said the Medicaid population isn't the only priority.

Many experts have told the commission that it is actually the Medicaid population and the wealthy who have the best access to mental health services.

"The vast middle (class) has almost no access so addressing that access is critical," Jackson said. Many people who are on commercial insurance can call around for a long time until they find someone who is taking patients, he said. There is also a high denial rate by insurance companies, he said.

He said he also wasn't sure what he thought of Malloy's proposal to cut $63 million from mental health services because he didn't have all of the information.

He said he did understand from speakers, that the current system is "limited to broken." So throwing money at it doesn't solve problems, he added.

He said he would rather help develop a better system and fund the better practices.